DIETARY SUPPLEMENTS

Advances in technology may someday into the future determine your daily nutritional needs with a simple test at home, where for example a pinprick of blood could indicate nutritional deficiencies.   An app on your cellphone would then, for instance, tell you to cut down on the red meat to twice a week, eat more colourful vegetables, and increase the intake of your vitamin D3 supplements by 4000 International Units (IU) and Magnesium Glycinate by 100 mg a day.   All scientifically based on your specific nutrient deficiencies and dietary supplements can then contribute to good health and a longer lifespan.

We are not there yet, but nutrition and nutritional supplements will become more personalized into the future, based on blood levels and genetics.  Comprehensive tests are currently available, but prohibitively expensive for now.

Meanwhile, selecting the nutritional supplements that are right for you can be a minefield and in many cases at best a shot in the dark.  Long isles of supplements in large pharmacies and health shops offers a wide selection of supplements but how do you select what is right for you?  Or is it best to select a multivitamin with ten or more ingredients for a shotgun approach?  Is a more expensive product any better than a cheaper version?  Does the supplement contain the ingredients that it claims on the label?  Which brand to choose?

To make matters worse, natural medicine is not regulated in South Africa, as the South African Health Products Regulatory Authority does not have any legal jurisdiction to regulate natural medicine.  A national database is also lacking.  In some other countries such as Canada one can look up a product online and by entering the proprietary name of a dietary supplement, find information about its safety, quality, and efficacy.

A national survey in the USA found that 52% of the surveyed adults use at least 1 dietary supplement and 31% reported that they use a multivitamin-mineral supplement.  Their most stated reason for using supplements is to fill nutrient gaps in the diet and for overall health and wellness.  Seeing that cardiovascular disease and cancer account for half the deaths in the USA, a studies-based review of the efficacy of supplementation for reducing the risk of cardiovascular disease, cancer, and mortality, as well as the harms of supplementation in the general adult population, was undertaken by the US Preventative Services Task Force.  (This Task Force makes recommendations about the effectiveness of specific preventive care services for patients and base its recommendations on studies-based evidence of both the benefits and harms of the service and an assessment of the balance.)

The Task Force found insufficient evidence to determine the balance of benefits and harms of supplementation with multivitamin-mineral supplements or single or paired nutrients (other than beta carotene) for the prevention of cardiovascular disease or cancer.  Some studies found an increased risk for cardiovascular disease, and an increased risk for lung cancer for smokers, with beta carotene supplementation over long-term studies (4-12 years of follow-up), but it must be said that moderately high doses of 20 and 30 mg/d was administered in the studies.  (Beta carotene is a nutrient that the body readily converts to vitamin A and it is known to support eye health.  It is a fat-soluble nutrient that can accumulate in the body, especially in the liver, and is toxic in high doses.)  

It is a safe bet to check with your medical practitioner or a qualified dietician before taking any supplements, as it may affect chronic medication or certain health conditions, such as pregnancy, diabetes, heart disease, or hypertension.  Some supplements may interact with prescription medication or even some over-the-counter medicines.  For example, St. John’s Wort may affect the efficacy of prescription medication for conditions such as heart disease, depression, seizures, certain cancers, or affect oral contraceptives, warns Natural Medicine World.  

Guideline when researching a supplement:

Local consumers have no option but to do their own research before selecting a supplement.  A few pointers may assist to identify a quality product by evaluating information about the product and the manufacturer.

• Is the manufacturing company well established with a good reputation?
• Are there easily assessable sources of information available on the manufacturer’s website?
• Does the manufacturer make only one product or various products?  (Manufacturing only one product may indicate a small or even a fly by night operation.  Large manufacturers may have more resources to do proper research and development.)
• Were any trials (studies) done on the product?
• Are the ingredients listed on the container in the same dose that was used in the study?
• Is it in the same form (tablet, capsule, or liquid) that was used in the study?  Which form is best absorbed?
• Is the right part of the plant used to make the supplement?  For example, the root may contain the purest form of the specific ingredient, but disreputable manufacturers may use the rest of the plant which is cheaper, and the product may be of inferior quality.  This could lead to falsified information that the correct herb is present in the supplement, although not the right part of the plant or the correct compound.  For example, a plant such as ginseng is studied for the efficacy of its root.  As the root is expensive, the rest of the plant is either discarded or sold cheaply.
• Did a third party do or verify the testing in a study, or was testing done by the manufacturer, which may be biased.?
• Are the ingredients made from organic or chemical raw materials?
• Are there any indications or proof of the interaction and synergy between the ingredients when they are all put together in a single supplement?   (Certain ingredients may have synergy in the short term but may create some issues over the longer term.  Getting too much of some ingredients may lead to toxicity.)
• Be careful of ridiculous claims and “wonder products”, there are no magic bullet ingredients – yet.
• Premium products are usually more expensive.
• Be careful of a supplement with a long list of ingredients (more than 3-6), as the quantities of some (or even all) of the ingredients may be too low to be effective.  Ingredients should have complementary mechanisms of action at the right dose. 
• As a rule of thumb, product claims should be based on the entire product, not one or more of the ingredients.  Testing is best done through a placebo-controlled, double-blind trial with healthy individuals, with the claims based on statistically significant findings.

Which supplement is right for you?

As mentioned before, there are no quick and easy home tests available to determine what your body really needs.  Comprehensive blood tests can give a good indication of any deficiencies which need to be supplemented.  Blood tests which highlighted a specific problem should be repeated after 3 – 6 months to determine whether the supplement and any other interventions were effective.

Supplements are, as the name says, supplementary to a healthy diet and a healthy lifestyle, which includes regular exercise.

There are, however, certain supplements that are highly rated.  A well-known Ingredientologist and “Formulator” of ingredients and supplements in the USA, Shawn Wells – who has formulated more than 500 products and patented over 30 novel ingredients – says the choice of which supplements to take comes down to bio-individuality.  Different bodies need different supplements.  He has however compiled a list of the top 10 best supplements, in his view.

• Berberine:  Wells believes that Berberine is the most important supplement to take, as it is a powerful ingredient to battle aging and disease, as well as promoting wellness.   Berberine is an extract that comes from various herbs used in traditional Chinese medicine.  It helps with the management of blood sugar levels as its potential benefits include the lowering of blood glucose and improving insulin sensitivity.  Berberine is claimed to have powerful antioxidant, antimicrobial, and anti-inflammatory properties.
• Multivitamin with Methylcobalamin & 5-MTHF:  Methylcobalamin is a naturally occurring and active form of vitamin B-12 and plays a role in the synthesizing and metabolizing of the neurotransmitter serotonin, which regulates mood.  5-MTHF is an active form of folate, which supports methylation, a chemical reaction in the body in which a small molecule called a methyl group gets added to DNA, proteins, or other molecules.  Methylation is dependent on the availability of several key ingredients, especially folate.
• High DHA fish oil:  Fish oil is a good source of omega-3 and the two most important long-chain poly-unsaturated fatty acids formed from omega-3 are EPA (eicosapentanoic acid) and DHA (docosahexanoic acid).  EPA levels seems to correlate with mood.  DHA levels are linked to improvement of memory and reaction time, eye health and vision, while it has been found to elevate levels of an important growth factor for the brain and central nervous system, namely brain-derived neurotrophic factor (BNNF).  DHA also plays a role in improving markers for heart health, and in promoting a healthy inflammatory response.  DHA is the most predominant fatty acid found in brain and eye tissue.
• Prebiotics, Probiotics, & Postbiotics:  The human digestive system is host to trillions of microbes – bacteria, viruses, fungi – of which bacteria forms a big component.  Prebiotics refer to short-chain fibers in the diet that are fermentable and used for fuel by the gut bacteria.  Probiotics refer to supplements that replenish the “good” beneficial bacteria in the gut.  Probiotics help to minimize harmful microorganisms, advance a healthy balance of gut bacteria, assist with a healthy digestive tract, and assist with digestion and the absorption of nutrients.  Postbiotics refer to the bioactive compounds that probiotic bacteria produce when they consume fiber (prebiotics). 
• Vitamin D3 and K2:  There are many vitamin D3 receptors located throughout the body and deficiency of vitamin D3 has been associated with several conditions, for example depression and increased susceptibility to viral infections.  In fact, studies have shown that vitamin D3 deficiency was linked to a significantly increased risk for serious COVID-19 infections.
• Collagen:  Collagen protein in its hydrolyzed collagen peptides form is high in the building blocks that make up the collage-containing tissues in the body, such as tendons, ligaments, joint cartilage, and muscles.
• Curcumin/Tetrahydracurcumin:  Curcumin is a naturally occurring organic compound (polyphenol) and is the beneficial compound found in turmeric.  Curcumin is associated with the benefits ascribed to turmeric, such as its anti-inflammatory effects and support for the body’s antioxidant and detoxification systems.  Turmeric belongs to the ginger family and has been used for ages in Indian holistic medicine.  As curcumin has poor solubility and absorption, it is best to find a liposomal supplement, which means a drug preparation that contains the active ingredient inside tiny fat-like particles, which form is easier for the body to absorb. A new form of curcumin called tetrahydrocurcumin is deemed to be superior for fighting inflammation, antioxidant activity, and bioavailability.
• Alpha-GPC:  Alpha-glycerolphosphorylcholine (Alpha-GPC) is a naturally occurring choline compound that can cross the blood-brain barrier, so it helps to deliver choline directly to brain cells, where it is used for various brain functions.  Choline is the main building block for the neurotransmitter acetylcholine, which, amongst others, facilitate communication in brain areas associated with memory, concentration, and triggering muscle contraction.  Supplementation may offer potential mental and physical benefits such as improved cognitive function, increased power output, and increased growth hormone production.  It may help to treat cognitive dysfunction and improve memory and thinking skills.
• Creatine:  Creatine is a well-known and well-studied sports nutrition supplement and is known to improve performance, build muscle, and increase strength.
• Ashwagandha & Rhodiola Rosea:  These medicinal herbs are adaptogens, which means they are natural substances that help the body adapt to stress.  They have active ingredients that could impact how the body deals with stress, anxiety, and fatigue.  Ashwagandha is a powerful adaptogen and improves the body’s ability to cope with stress.  It also has the capacity to improve energy levels, as it can reduce the activity of the enzyme that breaks down ATP (adenosine triphosphate), which is the source of energy for use and storage at the cellular level.  It is deemed to have beneficial effects on mitochondrial functioning.  It is also known for its ability to slow the aging process, promote health and longevity, combat stress, and improve feelings of well-being.  Ashwagandha is an evergreen scrub that grows in the arid parts of India, also found in parts of Asia and Africa.  The root has been used for centuries in powder form in traditional Indian medicine.    Rhodiola is deemed to help normalize numerous systems and functions in the body, which includes the adrenals and the body’s stress response.  This herb is deemed to strengthen the body’s immune response and increases the body’s ability to cope with physical and mental stress.  It is also used for relieving fatigue and improving concentration and memory.  Rhodiola is a perennial flowering plant that grows naturally in the cold parts of Europe, Asia, and North America.  Its roots have been used for centuries in traditional medicine to treat fatigue, anxiety, depression, and stress. 

Wells says he regularly recommends these ten supplements but warns “you can’t out-supplement a bad diet, so begin by eating more whole foods, less processed foods, and drinking more water”.  He adds that if you lead a sedentary lifestyle, you should add a daily ten-minute walk.

Conclusions:

The dietary guidelines of the US Department of Health and Human Services suggests that nutritional needs should be met primarily from nutrient-dense foods and beverages.  The American Heart Association recommends that healthy persons should receive adequate nutrients by eating a variety of foods in moderation, rather than by taking supplements.

Following a healthy diet remains the best source of nutrients, vitamins, and minerals.     The Mediterranean Diet has over the years been proven as the healthiest diet to follow, as it has in 2022 for the fifth time in a row been awarded with the top spot in an annual evaluation in the USA.  A panel of 27 experts examined 40 diets and ranked the Mediterranean Diet as the best overall diet to follow.

The Mediterranean way of eating and living focusses on a plant-based diet, physical activity, and social interaction.  A healthful diet, getting enough exercise, maintaining a healthy weight, not smoking, and social engagement can reduce the risk for many health conditions, for example dementia, depression, high cholesterol, and could contribute to a longer life.

While supplements are no substitute for a healthy diet and a healthy lifestyle, it can provide a nutritional back-up if your diet eliminates certain food groups or lack a variety of healthy foods.  Absorption of some vitamins fades with aging and seniors may need additional supplementation of certain vitamins, for example vitamin B12 and B6, and vitamin D.

Supplements can’t undo an unhealthy diet and lifestyle, but they can help to fill in the gaps.  As the name implies, supplements are only meant to be supplementary! 

References:

Tips on discerning dietary supplement use.  Published online.  Natural Medicine World.  (www.natmedworld.com)

Are you wasting your money on supplements?  Most likely, experts say.  Published 21 June 2022.  CNN Health.  (www.cnn.com)

Mediterranean diet named best diet for 2022.  Published 21 June 2022.  CNN Health.  (www.cnn.com)

9 Tips to help you choose a quality supplement.  Published online.  Shawn Wells.  Ingredientologist.  (www.shawnwells.com)

Top 10 best supplements you should be taking.  Published online.  Shawn Wells.  Ingredientologist.  (www.shawnwells.com)

Vitamin, mineral, and multivitamin supplementation to prevent cardiovascular disease and cancer.  US Preventive Services Task Force Recommendation Statement.  Published 21 June 2022.  Journal of the American Medical Association (JAMA).   (www.uspreventiveservicestaskforce.org)

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